Does the Association Between Fatigue and Fatigue Self-management Preference Vary by Breast Cancer Stage?

BACKGROUND: Cancer-related fatigue (CRF) is a major issue facing breast cancer survivors (BCS) that can negatively impact their symptoms and quality of life. OBJECTIVES: The aims of this study were to examine levels of fatigue, identify preferred types of fatigue self-management, and explore the relationship between fatigue levels and management choices by cancer stage. METHODS: This cross-sectional descriptive study included 229 BCS recruited from 5 hospitals in Korea. The study inclusion criteria were limited to BCS between 20 and 69 years old in stages 1, 2, or 3 who were undergoing or had completed active therapy. The Revised Piper Fatigue Scale and a questionnaire developed for fatigue management were used for data collection. RESULTS: The stage 2 group experienced more fatigue (mean, 5.31) than the other cancer stage groups, and significant differences in fatigue were found between stages 1 and 2 (P < .001). Fatigue self-management choices showed different correlations with fatigue levels in each stage. Physical activity control was most frequently used in stage 1, whereas exercise was most frequently used in stages 2 and 3. Multivariate regression analysis showed that exercise consistently and effectively decreased all fatigue dimensions. CONCLUSION: Stage 2 BCS experienced the greatest level of CRF, and fatigue levels and management choices differed in BCS by cancer stage. IMPLICATIONS FOR PRACTICE: Recognizing how CRF and patients' preferences for fatigue self-management may differ by cancer stage can alert clinicians in assessing CRF and tailoring effective fatigue management for BCS.

A randomized trial of dyadic peer support intervention for newly diagnosed breast cancer patients in Korea.

BACKGROUND: At the time of diagnosis, patients with cancer are highly exposed to the risk of psychological morbidity. The effects of psychosocial intervention for newly diagnosed cancer patients have not been extensively studied. OBJECTIVE: The objective of this study was to test the effects of a dyadic peer support intervention on self-efficacy, anxiety, depression, and mental adjustment among newly diagnosed breast cancer patients in Korea. METHODS: This study used a randomized controlled trial design. One hundred twenty-nine patients were recruited within 1 month of diagnosis with breast cancer in the National Cancer Center in Korea. The study participants were randomly assigned to either experimental (n = 64) or control (n = 65) group. The experimental group underwent dyadic peer support intervention during the 6 weeks after surgery. The control group received the usual care. RESULTS: There was a significant difference in changes in self-efficacy for self-management of breast cancer between the experimental and control groups; however, no significant changes were observed in anxiety, depression, and mental adjustment between the 2 groups. CONCLUSIONS: A 6-week dyadic peer support intervention was feasible and effective for increasing self-efficacy for self-management among newly diagnosed breast cancer patients in Korea. However, this intervention did not improve other psychological outcomes. IMPLICATIONS FOR PRACTICE: Oncology nurses are optimally positioned to promote adjustment in patients with cancer. Trained peer support partners, supervised by skilled nurses, may be useful in improving self-efficacy of patients newly diagnosed with breast cancer.

Validation of the Energy Conservation Strategies Inventory (ECSI).

CONTEXT: In applying good energy conservation strategies to relieve cancer-related fatigue, it is critical to first identify cancer patients who are at a high risk for poor energy conservation. However, instruments have not been developed to evaluate energy conservation strategies in an oncology setting. OBJECTIVES: The aim of this study was to validate an instrument that cancer patients may use to evaluate energy conservation strategies to overcome cancer-related fatigue. METHODS: The questionnaire development followed a four-phase process: 1) item generation and reduction, 2) construction, 3) pilot testing, and 4) field testing. Using relevant and priority criteria, as well as pilot testing, we developed a 25-item questionnaire. After field testing, five items were discarded. Finally, 20 items were included in the Energy Conservation Strategies Inventory (ECSI). Factor analysis, multitrait scaling analysis, and Cronbach's α were used to determine the construct validity and reliability. RESULTS: Factor analyses of data from 140 cancer patients resulted in the ECSI, which covers activities related to planning, overcoming distractions, labor saving, burden reducing, and comfort. All subscales (Cronbach's α range, 0.69-0.78) and total scores (Cronbach's α=0.87) were found to possess acceptable internal consistency. CONCLUSIONS: The good psychometric properties of the ECSI instrument show that it may be useful for measuring the frequency of energy conservation strategies used by cancer patients.

Symptoms and uncertainty in breast cancer survivors in Korea: differences by treatment trajectory.

AIMS: The study compared the levels of symptoms and uncertainty, their associated factors, relationships between them and predictors of uncertainty by treatment trajectory among breast cancer survivors. BACKGROUND: Little is known with regard to how uncertainty and symptoms are related to treatment trajectory among breast cancer survivors. DESIGN: A cross-sectional descriptive design was used. METHOD: A total of 252 women with breast cancer, receiving cancer therapy, or having completed their therapy were recruited from the National Cancer Center in Korea. Measurements used included symptom subscales of the European Organization of Research and Therapy for Cancer QLQ-C30 and Breast Cancer Module BR23 and the Mishel Uncertainty in Illness Scale. RESULTS: Women in treatment reported more severe symptoms and higher levels of uncertainty than women having completed treatment. During treatment, most symptoms were positively correlated with the level of uncertainty, whereas, in women who had completed treatment, only dyspnoea, insomnia, systemic therapy side effects and arm symptoms positively correlated with uncertainty. There were also differences in predictors of uncertainty by treatment trajectory. Age, marital status and pain were significant predictors of uncertainty during treatment, while monthly income, dyspnoea and insomnia were predictors of uncertainty after treatment. CONCLUSIONS: Among breast cancer survivors, levels of symptoms and uncertainty, associated factors, relationships between them and predictors of uncertainty differed depending on treatment trajectory. RELEVANCE TO CLINICAL PRACTICE: To provide trajectory-sensitive nursing intervention for uncertainty among breast cancer survivors, age, marital status and pain should be considered during treatment, while factors such as economic status, dyspnoea and insomnia should be taken into account after treatment.